(Behavioral) Theories of Health & Physical Activity

KNES 400 Session 5

Instructor: Dr. Shannon Jette

Learning Objectives Discuss the purpose of theoretical frameworks Discuss behavioral theories that provide

insight into the mechanisms underlying the relationship between intra- and inter-personal factors and health-related behaviors Discuss shortcomings of such theories !

Theoretical Frameworks

Help us to interpret or understand a situation or problem; often abstract and applicable to a broad range of situations Help us to answer why? What can be changed?

Socio-ecological model

Dahlgren!&!Whitehead,!1991!

What are factors influencing health? Determinants, correlates Where/how can we intervene?

Socio-Ecological Model Poli4cal/Macro8

economic!!

Environmental!

Organiza4onal!

Interpersonal!

Intrapersonal!

Ecological Framework multiple levels of influence

Concept Deni+on

Intrapersonal!level Individual!characteris4cs!that!inuence!behaviors!such!as!knowledge,!aFtudes,!beliefs!and!personality!traits

Interpersonal!level Interpersonal!processes!and!primary!groups,!including!family,!friends,!and!peers!that!provide!social!iden4ty,!support!and!role!deni4on

Organiza4onal!level

Rules,!regula4ons,!policies,!and!informal!structures!that!may!constrain!or!promote!recommended!behaviors

Environmental!level

Aspects!of!the!social!(networks,!norms),!built!(infrastructure!&!community!design)!and!natural!(weather,!topography)!that!inuence!behaviors

Poli4cal!(policy)!level

Local,!state,!federal!policies!and!laws!that!regulate!or!support!un/healthy!ac4ons

Adapted!from!DHHS,!2005!

Adapted ecological model of correlates of physical activity

Bauman et al., Lancet, 2012, 380: 258-71

But in addition to this broad model

Have theories that help to explain behavior (PA or health-related) at various levels of the socio-ecological model

For many years, theories focused on intra- and inter-personal levels, and aimed to Identify the influential variables that predict PA behavior

(i.e., correlates) Develop strategies to manipulate variables and bring

about changes in PA levels

Dominant theories: Cognitive-Behavioral!

1. Behavior is mediated by cognitions; that is, what people know and think affects how they act

2. Knowledge is necessary for, but not sufficient to produce, most behavior changes

3. Perceptions, motivations, skills (& the social environment) are key influences on behavior

!

Key Cognitive Behavioral Theories

Health Belief Model (HBM) Stages of Change (Transtheoretical) Model Theory of Planned Behavior Precaution Adoption Process Model Social Cognitive Theory (SCT)

Health Belief Model (HBM)

Six main constructs Perceived susceptibility Perceived severity Perceived benefits Perceived barriers Cue to action Self-efficacy (later added) !

Health Motivation is central focus why people take action to prevent, screen for or control illness conditions

Modifying Factors Individual Beliefs Action

Age Gender Personality Socioeconomics Knowledge

*Perceived susceptibility to & severity of disease

Perceived benefits

*Perceived barriers

Perceived self efficacy

Individual behaviors

Cue to action

HBM Components and Linkages

Adapted from Glanz et al., 2008

Perceived threat

Theory of Planned Behavior

Behavioral Intention is viewed as most important determinant

Behavior Behavioral Intention

Attitude toward

behavior

Subjective norm

Perceived behavioral

control

Belief about what

behavior entails

Evaluation of behavior outcome

Normative beliefs

Motivation to comply

Control beliefs

Perceived Power

Adapted from Glanz et al., 2008

Qualitative study of barriers to concussive symptom reporting in high school athletics (Chrisman et al., 2013)

young ppl knew that they should take themselves out the game

didnt want to let down teammatesor seem weak

Interventions premised upon Intrapersonal Cognitive Behavioral Theories

Some level of success but questions about effectiveness Gap between peoples intentions and behaviors; b/n

feelings of self efficacy and behaviors Premised on notion of rational What about AFFECT/EMOTIONS, including pleasure?

Reductionist tend to describe behavior in isolation of social and cultural context

Thurston,!Behavior!Change,!2014!

public health: getting ppl to deny things thatmakes them feel good

dont consider behavior in the wider context: ex: single low income mothers have higher levels of smoking; interviews showthat smoking is a huge stress relief/social norm (other factors)

At interpersonal level

Theories of health behavior assume individuals exist within and are influenced by a social environment Individual has reciprocal effect on social

environment Emphasis on human capacity for learning and

adaptation

Key Concepts in SCT Reciprocal determinism: Personal, behavioral and

environmental factors act as mutual causes of each other

Self-efficacy: situation specific self-confidence (beliefs one can execute behavior, overcome barrier)

Outcome expectances: beliefs that behavior will result in salient outcomes (esp. how person feels about him or herself)

individuals not just impacted by env. but also can shape their environment

Interaction of Self Efficacy with Environment

Responsive Environment

Unresponsive Environment

Low self efficacy

High self efficacy

Putting theory to practice?! Targeted Interventions Many work on improving self efficacy for desired

behavior Mastery experience Social modeling Self monitoring techniques Goal setting and self-reward

Group change (social support in community settings) Policies to change environment to make healthy

choice easier

: someone similar who achieved the task

: write down context as to explain behavior (ex: depressed= smoking)

:change social norms in the group

Cognitive-Behavioral Models - Critiques Constructs based on white, middle class norms Created by and tested upon

Dominant Values: Independence, choice, control in other words AGENCY, but a particular version of

agency

Stephens et al. (2009) Why did they choose to stay?

Study 1: how observers perceived survivors who evacuated (leavers) or stayed (stayers) Leavers described positively (as agentic, independent

and in control) Stayers described negatively (passive and lacking

agency) Observers perceptions reflect disjoint model of agency

prevalent in white, mc contexts = good action are those that emanate from within individual and act upon environment

Stephens et al. (2009) Why did they choose to stay?!

Study 2: interviews with survivors and found that leavers and stayers relied on divergent models of agency Leavers emphasized independence, choice and control

Predominantly white, middle class Stayers emphasized interdependence, strength and

faith Predominantly black, lower income Conjoint model of agency: good actions as those that adjust

to the environment and promote interdependence with others

Cognitive-Behavioral Models - Critiques! Insufficient attention to manner in which social structure

is internalized and normalized in an individuals unconscious? Manner in which unequal distribution of resources leads to

reproduction of unequal life chances and limitations of choice? Varying forms of CAPITAL

(more to come on this ) Might behavior change interventions lead to widening

of health inequalities as those born into privilege experience themselves as agents of their own destiny?

Socio-Ecological Model Poli4cal/Macro8

economic!!

Environmental!

Organiza4onal!

Interpersonal!

Intrapersonal!

Additional theories or frameworks

Critical race theory Structural discrimination Intersectionality Habitus (lifestyle as a reflection of social structure) Political economy Disciplinary power and Biopower